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NPI Code Detail

MEDICARE: JATHAN CANTU M.D.

MEDICARE: JATHAN CANTU M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician2003-0193NM
2207Q00000XFamily Medicine PhysicianG8036TX

General Provider Information

NPI Number : 1932174596
Entity Type Code : Individual
Provider Name (Legal Business Name) : JATHAN CANTU M.D.
Provider Business Mailing Address
First Line : 300 WILSON ST
Second Line :
City : HENDERSON
State : TX
Zip : 75652-5956
Country : US
Telephone Number : 903-655-6536
Fax Number : 903-655-4009
Provider Business Practice Location Address
First Line : 300 WILSON ST
Second Line :
City : HENDERSON
State : TX
Zip : 75652-5956
Country : US
Telephone Number : 903-655-6536
Fax Number : 903-655-4009
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2006
Last Update Date : 11/05/2020

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